Midsumma Patron Registration
Full Name
Please enter your preferred first name then your family name, in that order.
Your answer
Organisation / Company
Only relevant if your company or organisation is paying the patron fee
Your answer
Email address
Your answer
Postal Address
Your answer
Phone
Preferred phone number for contact during business hours
Your answer
Mobile phone number
Your answer
What is the total amount of your tax-deductible donation?
Midsumma has four levels of patron: Diamond Patron ($5,000+), Gold Patron ($2,000 – $4,999), Silver Patron (1,000 – $1,999) or Rainbow Patron ($500 – $999).
Your answer
Do you wish for your patronage to remain anonymous?
Unless you tick the box below, you will be recognised in the Midsumma Printed Program guide and online
Payment method
How would you like to make your payment?
Submit
Never submit passwords through Google Forms.
This form was created inside of Midsumma. Report Abuse - Terms of Service - Additional Terms